Extensive Maxillary Medication-Related Osteonecrosis of the Jaw Treated with Surgical Resection and Prosthetic Rehabilitation: Functional Recovery and Improved Quality of Life

Abstract Medication-related osteonecrosis of the jaw (MRONJ) presents significant challenges in advanced stages, particularly when extensive bone involvement leads to functional impairment. In patients with metastatic cancer receiving antiresorptive therapy, the role and timing of surgical intervention remain complex, requiring careful consideration of systemic status, disease extent, and patient priorities. A 56-year-old woman with breast cancer and multiple bone metastases treated with denosumab presented with extensive maxillary MRONJ, characterized by widespread bone exposure, tooth mobility, and loss of occlusion, resulting in difficulty with oral intake. Computed tomography demonstrated a large sequestrum extending across the maxilla with a separation pattern resembling a Le Fort I fracture. Given the patient's strong preference for active treatment, functional impairment, and relatively stable systemic disease, sequestrectomy was performed under general anesthesia along the natural line of separation, preserving viable bone. Despite a substantial oroantral communication, complete mucosal closure was achieved, allowing conventional prosthetic restoration without an obturator. This resulted in recovery of occlusion, improved facial appearance, and restoration of oral intake. Antiresorptive therapy was resumed postoperatively without recurrence. This case highlights that even in extensive MRONJ with systemic comorbidity, patient-centered decision-making and anatomically conservative surgery can facilitate prosthetic restoration and meaningful improvement in quality of life.